Conservative pancreatic resection in patients with obstructive chronic pancreatitis

The purpose of this paper is to present the results of our experience in using a conservative pancreatic resection approach in a certain group of patients suffering from chronic pancreatitis. From January 1988 to December 1995, 110 patients underwent surgical therapy for chronic pancreatitis at the Hospital Clinic of the University of Barcelona. In 35 patients with an inflammatory mass at the pancreatic head, pylorus-preserving duodeno-pancreatectomy was performed. Forty male patients with localized focal pancreatitis at the body or tail underwent distal pancreatectomy and drainage of the pancreatic remnant. In 30 patients with pancreatic ducts greater than 7 mm in diameter, side-to-side pancreaticojejunostomy was carried out. Five patients could not be included in any of these three categories because of their particular characteristics. In all cases, resolution of the symptoms was achieved at the mean follow-up of 18 months (range 12 to 21 months). No patient showed a deterioration of glucose homeostasis, and exocrine dysfunction was not observed. Patients with obstructive chronic pancreatitis by inflammatory cystic mass, short strictures or intraductal stones located in the central pancreas or uncinate process may be surgically managed with conservative pancreatic resection or extraction of the stones from the Wirsung duct. The jejunal interposition and pancreaticojejunal anastomosis achieved pain control without any deterioration of the endocrine or exocrine function.